Vol 48 No 3 (2019)

Review Article(s)

  • XML | PDF | downloads: 406 | views: 880 | pages: 371-378

    Down syndrome (DS) is one of the most prevalent genetic disorders in humans. The use of new approaches in genetic engineering and nanotechnology methods in combination with natural cellular phenomenon can modify the disease in affected people. We consider two CRISPR/Cas9 systems to cut a specific region from short arm of the chromosome 21 (Chr21) and replace it with a novel designed DNA construct, containing the essential genes in chromatin remodeling for inactivating of an extra Chr21. This requires mimicking of the natural cellular pattern for inactivation of the extra X chromosome in females. By means of controlled dosage of an appropriate Nano-carrier (a surface engineered Poly D, L-lactide-co-glycolide (PLGA) for integrating the relevant construct in Trisomy21 brain cell culture media and then in DS mouse model, we would be able to evaluate the modification and the reduction of the active extra Chr21 and in turn reduce substantial adverse effects of the disease, like intellectual disabilities. The hypothesis and study seek new insights in Down syndrome modification.



  • XML | PDF | downloads: 306 | views: 955 | pages: 379-387

    Background: Magnesium (Mg) is an essential element for the body. It is a cofactor for ATP, DNA, and RNA and more than 600 enzymes. As it is similar to Ca2+, this element can also act as a cell signaling molecule and play multiple important roles in the nervous, muscle, and immune systems. Recent studies have associated Mg-deficiency with many neurological disorders, such as cerebral vasospasm, Alzheimer’s disease, stroke, and migraine. As it plays such a crucial role in human body, therefore, we summarized the role of Mg in neurological disorders to illustrate the symptoms caused by Mg-deficiency and the possible underlying mechanisms.

    Methods: We critically discuss the role of it that we review the recent literature of magnesium. We also review the available data which are concerning the role of magnesium in neurological disorders.

    Results: Magnesium is related to neurological disorders on the basis of the study of animals and humans experiments. Furthermore, these nervous systems related diseases include cerebral vasospasm, Alzheimer’s disease, Parkinson’s disease, stroke and migraine.

    Conclusion: Magnesium has effects on neurological disorders, such as its utility in cerebral vasospasm, Alzheimer’s disease, Parkinson’s disease, stroke and migraine. So here we make a brief review to conclude it.



  • XML | PDF | downloads: 257 | views: 804 | pages: 388-399

    Background: The color of the skin is highly heritable but can be influenced by the environments and endocrine factors. Many other factors, sometimes destructive, are also involved in the formation of skin color, which sometimes affects pigmentation patterns. Vitiligo is an autoimmune hypopigmentation painless disorder with appearance of white patches and psychological effects on patients. It is a disease in which melanocytes of the skin are destroyed in certain areas; therefore depigmentation appears.

    Methods: We studied more than 60 articles. Several therapeutic methods have been used to return the color of skin in vitiligo. These methods include non-invasive treatment and surgical techniques. Among all these therapies, cell transplantation is an advanced procedure in regenerative medicine. Extraction of melanocytes from normal skin and then their cultivation in the laboratory provides a large number of these cells, the transplanting of which to depigmentation areas stimulates the site to irreversibly produce melanin.

    Results: The transplantation methods of these cells have been evolved over many years and the methods of producing blister have been changed to the injection of these cells to the target sites.

    Conclusion: In this review, autologous cultured melanocyte transplantation has been considered to be the most viable, safe, and effective method in the history of vitiligo treatments.


  • XML | PDF | downloads: 417 | views: 992 | pages: 400-409

    Background: Global experience as well as expert views weight the Family Physician program (FPP) as a primary solution for various problems of healthcare system in Iran. In spite of the valuable information has been collected during conducting FPP, few studies have been done to evaluate the actual performance of this program. This study reviewed the studies related to the evaluation of the FPP systematically.

    Methods: The authors systematically searched PubMed, Web of Science, Scopus, Embase, Irandoc and SID for articles published in English and Persian until Nov 2017 without limitation for starting time. Selection stages of the articles were done based on PRISMA flow diagram guidelines.

    Results: Of all articles evaluated, 19 were selected. Four articles were removed due to inadequate quality of the study. Only one article evaluates urban and the rest are about rural. Eight articles were categorized as the process evaluations and 12 outcome assessments (one of them was common).

    Conclusion: We achieved three main findings. First, the rural FPP has improved access to the healthcare services, but improvement in patient finding and quality of cares remains questionable. Second, there are considerable concerns in the referral system between levels I and II in both urban and rural programs. Third, there was no efficient planning to implement the FP as the gatekeepers of health care system effectively. These issues deprived the efficiency aim of FPP and need serious consideration.


  • XML | PDF | downloads: 207 | views: 732 | pages: 410-420

    Background: Association of Selenium (Se) deficiency, an essential trace element, has been found with human diseases. Identifying literature trends on the effects of Se on the thyroid may guide in planning future studies.

    Methods: A literature search was conducted using the Web of Science database to identify studies on Se and the thyroid published over the 20 years duration (1995-Dec 2014). Scientometric indices were used to draw field maps. The scientific processes, structure, evidence history, and international collaborations were included in the map. The most influential authors, journals, institutions, and countries were also examined.

    Results: Our search identified 184 research and review papers. The number of scientific studies on Se and the thyroid has been irregular, but interest in this topic has increased in recent years. The highest number of studies was published in 2014 (16 papers) and overall growth factor of publication was 3.78. Overall, 744 authors from 282 institutions in 43 countries published in this field. The author J. Kohrle (828 citations, 14 publications), and German scientists (1272 citations, 30 publications) were most influential.

    Conclusion: This study reveals the interrelationships between different publications on the effects of Se on the thyroid. Leading scientific issues and their extent of impact were successfully determined by examining citations. The results of systematic citations and mapping fields can be used to assist in policy and management contexts.

Original Article(s)

  • XML | PDF | downloads: 350 | views: 770 | pages: 421-428

    Background: We aimed to explore the effect of health education and nursing intervention model based on behavioral change theories on self-efficacy and self-management behaviors in patients with chronic heart failure.

    Methods: Eighty-six patients with chronic heart failure treated in the First Hospital Affiliated to Harbin Medical University (Harbin, China) from November 2016 to January 2018 were enrolled in this study. The patients were evenly divided into control group and observation group (43 patients in each group), according to the random number table method. Patients in the control group received a routine health education intervention. Patients in the observation group received health education based on behavioral change theories in addition to the routine nursing intervention. The health education included mastering of the disease-related theoretical knowledge, daily self-management and exercising guidance. After 8 weeks of intervention, the self-efficacy level, self-management ability and quality of life were assessed and compared between the two groups.

    Results: The self-management behavior score in the observation group was higher than those in the control group (P=0.002). The chronic disease general self-efficacy (GSE) score in the observation group was higher than those in the control group (P=0.002). The quality of life (MHL) score was in the observation group was higher than those in the control group. The patient satisfaction score in the observation group was higher than those in the control group (P=0.021).

    Conclusion: Health education based on behavioral change theories can relieve symptoms of chronic heart failure, and improve patients’ self-efficacy level, self-management ability and patient satisfaction.


  • XML | PDF | downloads: 176 | views: 591 | pages: 429-434

    Background: This study aimed to investigate secular trends of smoking among Thailand’s youths.

    Methods: We combined 8 datasets from national representative surveys between 1996 and 2015. Multi-stage cluster sampling was applied in all studies. Overall, 231459 participants aged 11-26 yr were included and analyzed. Participants were classified as current smokers if they responded “yes” to the question “Do you currently smoke?”, and former smoker if they reported no current smoking but had smoked previously. Age-period-cohort (APC) models were used to estimate age, period, and cohort effects on smoking for investigating secular trend of smoking.

    Results: The prevalence of smoking tended to decrease over time. Among those aged 11-14, the prevalence of current and former smoking was low but not negligible. Rates of underage smoking remained quite steady, around 3.8% in 1996 and 3.6% in 2015. The results of the APC model show that the prevalence of smoking among young male cohorts was lower than in older cohorts.

    Conclusion: Thailand’s tobacco control program has been effective in deterring youths from smoking. The prevalence of smoking in this population needs to be reduced further though, something achieved by reorienting tobacco consumption prevention campaigns towards this age group.



  • XML | PDF | downloads: 197 | views: 589 | pages: 435-443

    Background: To survey the prevalence of potential drug-drug interactions (DDIs) between anticancer drugs and non-anticancer drugs and evaluate the risk factors associated with these drug-drug interactions in China.

    Methods: All discharged patients in the Department of Oncology were collected from Jun to Dec in 2016 with the Hospital Information System of the Chinese people’s Liberation Army General Hospital. Drugs were screened for interactions by Micromedex solutions database. Descriptive statistics were generated and logistic regression was used to identify the associated factors.

    Results: Among 6578 eligible patients, 1979 potential drug interactions were found in 1830 patients (27.82%). The most common drug-drug interaction was cisplatin and furosemide. Erlotinib was most likely to interact with various non-anticancer drugs. Most interactions were classified as pharmacodynamics (71.60%), major severity (97.02%) and were supported by fair documentation evidence (86.21%). In multivariate analysis, increasing number of medications, lung cancer and patients with stage IV had a higher risk for potential drug-drug interactions.

    Conclusion: Potential drug-drug interactions between antineoplastic drugs and non-antineoplastic drugs occur frequently in cancer patients of Chinese hospitals. Doctors should fully consider potential risk associated with DDIs. Further research should be performed to evaluate real clinical significance of these drug-drug interactions.


  • XML | PDF | downloads: 160 | views: 686 | pages: 444-450

    Background: We aimed to investigate the analgesic effect and immune function of elderly patients with colon cancer after application of sevoflurane and isoflurane anesthesia.

    Methods: Overall, 130 patients with colon cancer in Yidu Central Hospital of Weifang  (Weifang, China) from February 2014 to January 2017 were collected and randomly divided into sevoflurane group (SEV group) and isoflurane group (ISO group). The pain score, immune indexes, postoperative cognitive index, extubation time, awakening time and S100R protein were analyzed.

    Results: The pain scores in SEV group at 5 min, 1 h and 3 h during surgery were significantly lower than those in ISO group (P=0.001, respectively). The levels of IL-6 in both groups of patients were higher at T1 and T2 than those at T0 (P=0.001). The levels of TNF-α in SEV group at T2 and T3 were significantly higher than that at T0 (P=0.001). The levels of CD80 in both groups of patients at T2 and T3 were obviously higher than those at T0 (P=0.001). Moreover, the extubation time, the response time to language and awakening time in SEV group were also remarkably shorter than those in ISO group (P=0.001). After continuous anesthesia in both groups of patients, the degrees of decline in ISO group were significantly higher than those in SEV group (P=0.001).

    Conclusion: Sevoflurane has a superior anesthetic effect to isoflurane in elderly patients with colon cancer, can reduce the degree of pain, improve the awakening condition and increase the immune function, so it is worthy of clinical application.





  • XML | PDF | downloads: 199 | views: 608 | pages: 451-457

    Background: There have been scientific studies on risk and protective factors associated with child outcomes. However, how risk factors interact to produce outcomes is not clearly understood. We assessed the association between school location, grade, and drug abuse risks among preschoolers.

    Methods: This cross-sectional study included 3353 participants aged 2-6 yr (mean: 4.6, SD: 1.03) enrolled in childcare centers and kindergarten classes in 2016 in Phuket, Thailand. The risk of drug abuse was measured using questionnaires, completed by teachers and caregivers. Data were analyzed using descriptive statistics, odds ratio with 95% confidence intervals and Chi-square.

    Results: The prevalence of drug abuse risk factors was as follows: sleep problems=1.28%, aggression=1.10%, attention-deficit hyperactivity disorder (ADHD)=3.61%, learning disabilities (LDs)=4%, family members’ substance abuse=12.53%, parents’ changing marital status=6.53%, conflict between parents/guardians=1.88%, family poverty=3.37%, and easy access to drugs in the community=5.16%. Sleep problems in children were significantly related to family members’ substance abuse, family poverty, and easy access to drugs in the community (PS<.05). LDs were significantly related to parents’ changing marital status, conflict between parents/guardians, family poverty, and easy access to drugs in the community (PS<.05). ADHD was significantly related to family members’ substance abuse, parents’ changing marital status, conflict between parents/guardians, and family poverty (PS<.05).

    Conclusion: The prevalence of drug abuse risks among preschoolers was 25.86%. Multidisciplinary teams should provide appropriate interventions.


  • XML | PDF | downloads: 158 | views: 450 | pages: 458-464

    Background: Carbon monoxide (CO) poisoning is one of the most important intoxications in the modern world. This study aimed to identify the characteristics of CO poisoning deaths in Sichuan province in the west of China.

    Methods: Data on fatal non-fire-related carbon monoxide poisoning in Sichuan from 2008 to 2016 were obtained from the Department of Forensic Analytical Toxicology of Sichuan University and were analyzed by the month and year of registration of death, sex, age group, manner of death, source of CO, and location of CO exposure. Comparing with the previous studies carried out in Wuhan and Shanghai to identify the regional differences of CO poisoning in China.

    Results: A total of 165 non-fire related CO poisoning cases including 237 victims were recorded. Over 90% of the victims died from accidental poisoning. Non-fire related CO poisoning occurred more frequently in winter months and was most prevalent in individuals aged between 18 and 60 yr old. Showering gas accident and coal or charcoal burning was found to be the major source of CO in accident and in suicide cases, respectively. Furthermore, significant regional differences of CO poisoning have been detected in the manner of death and the source of CO.

    Conclusion: These findings will be valuable in the targeted prevention of non-fire related CO poisoning in China.




  • XML | PDF | downloads: 223 | views: 516 | pages: 465-473

    Background: This study examined gender differences in the relationship between living alone and depressive symptoms in elderly Korean adults and the variables that influence this relationship.

    Methods: We conducted a secondary analysis using fourth-wave data from adults 65 yr of age or older who participated in the Korean Longitudinal Study of Aging. Depressive symptoms were measured using the 10-item short-form of the Center for Epidemiological Studies Depression Scale. Multiple logistic regression analyses were used.

    Results: After controlling for the factors of formal and informal social activities, financial support from children, employment, activities of daily living, instrumental activities of daily living, self-rated health, frequency of meals, and gender, living alone (AOR=1.45, 95% CI =1.09-1.93, P=0.010) was an independent risk factor that contributed to depressive symptoms in late life. Living alone was more likely to elevate depressive symptoms in older women but not in older men.

    Conclusion: Gender differences in the depressive effect of living alone in late life may differ across diverse cultures.


  • XML | PDF | downloads: 156 | views: 571 | pages: 474-483

    Background: County public hospital reform is one of the major tasks proposed in Chinese Healthcare Reform., and the evaluation of hospital reform effectiveness is very important and beneficial since it helps the government to understand the current situation of pilot county public hospitals and smoothly start the reform in all county hospitals.

    Methods: This study used hospitals data from 2009 to 2012 to evaluate the effectiveness of county public hospital reform through comprehensive service capability. Descriptive analysis method was used, and factor analysis method was used to extract the main factors associated with service capabilities as well as to calculate a composite score. The t-test of two independent-samples methods was used to comparison analyze.

    Results: The differences of common factor scores (hospital scale and service capacity, treatment quality, service quality, and services efficiency) between pilot and non-pilot hospitals were not statistically significant (P>0.05). The service capability score in 2012 was better than that in 2009 either in pilot or non-pilot group (P<0.05). The pilot hospitals’ service capability score was better than that in non-pilot groups either in 2010 or 2012 (P<0.05). However, the differences from 2009 to 2012 of service capability score between pilot and non-pilot hospitals were not statistically significant.

    Conclusion: The comprehensive service capability of both pilot and non-pilot group all got improvement. However, county public hospital reform did not significantly play a due good role in improving the service capability in pilot group. The reform was helpful to improve the hospital current situation, but it has not completely achieved policy objectives in the sample hospitals of this study.



  • XML | PDF | downloads: 182 | views: 476 | pages: 484-493

    Background: This study aimed to identify the effects of parenting attitude on life satisfaction and to analyze difference according to household income level.

    Methods: Data from 1977 adolescents participating in Korean Children and Adolescents Panel Survey V (2013) was analyzed. As a method of analysis, multi-group path analysis was performed.

    Results: Positive parenting attitude had a significant influence on both resilience and life satisfaction for adolescents, while it only influenced life satisfaction for parents. The effects of parenting attitude on life satisfaction of early adolescents were not different according to income level; life satisfaction of parents was different according to income level. Further, positive parenting attitude had a significant effect on life satisfaction of parents when they have lower income than average.

    Conclusion: Positive parenting has an effect on the psychological security of early adolescents, and the higher adolescents perceive their parents’ supports, the higher their life satisfaction is. Therefore, parenting attitude should be considered fully in the development of nursing interventions, in which physical and psychological approach to adolescents is important.



  • XML | PDF | downloads: 244 | views: 590 | pages: 494-500

    Background: This study aimed to investigate the effects of comprehensive nursing intervention in interventional therapy for patients with liver cirrhosis and liver cancer.

    Methods: Overall, 512 liver cirrhosis patients complicated with liver cancer receiving interventional therapy in the Department of Oncology of the Second Hospital of Dalian Medical University (Dalian, China) from March 2010 to March 2016 were retrospectively analyzed. Patients were divided into observation group (n=310) and control group (n=202). Comprehensive nursing intervention was applied to observation group and conventional nursing care was applied to control group.

    Results: The degrees of satisfaction before and after nursing intervention, quality-of-life scores, incidences of postoperative complications and survival rates at 20 months after operation of the two groups were compared. The degree of great satisfaction in observation group was significantly higher than that in control group (P<0.001). The quality-of-life scores of the patients in observation group were obviously higher than those in control group (P<0.001). The incidence of postoperative complications in observation group was significantly lower than that in control group (P<0.001). The survival rates in observation group was significantly higher than that in control group (P=0.035).

    Conclusion: The application of comprehensive nursing intervention in the interventional therapy for liver cirrhosis and liver cancer can notably improve the life quality of the patients, lower the incidence of postoperative complications and increase the survival rate, which is worthy of clinical popularization and application.


  • XML | PDF | downloads: 233 | views: 567 | pages: 501-507

    Background: Fasciolosis is a shared disease between humans and livestock caused by hepatic trematodes; Fasciola hepatica and F. gigantica. Differentiate between the two species of this genus is essential. High-Resolution Melting (HRM) Analysis represents a new approach to this issue. This method can be performed right after termination of Real-Time PCR. This technique has not been used for identification of adult F. hepatica and F. gigantica genotypes. The aim of this study was to determine Fasciola species by using HRM in isolates taken from Iran, respectively.

    Methods: Ninety-three Fasciola spp. samples were collected from infected slaughtered animals in different regions of Iran, including North West (Ardebil Province) and South East (Zahedan Province) during 2016. Genomic DNA from the samples was extracted using a DNA extraction kit and then after Real-Time PCR amplification, HRM was done.

    Results: Overall, 59 and 34 isolates were identified as F. hepatica and F. gigantica, respectively. The percentages of each species from animals were as follows: sheep (F. hepatica, 80.39% and F. gigantica, 19.61%), cattle (F. hepatica, 42.85% and F. gigantica, 57.15%).

    Conclusion: HRM technique developed in the present study is a powerful, rapid and sensitive technique for epidemiological survey and molecular identification between F. hepatica and F. gigantica.


  • XML | PDF | downloads: 223 | views: 606 | pages: 508-515

    Background: Reducing inequities in access to healthcare is one of the most important goals for all health systems. Financial barriers play a fundamental role here. People with disability (PWD) experience further financial barriers in access to their needed healthcare services. This study aimed to explore the causes of barriers in access to health services for PWD in Tehran, Iran.

    Methods: In this qualitative study, we used semi-structured in-depth interviews to collect data and selected participants through purposeful sampling with maximum variation. We conducted 56 individual interviews with people with disability, healthcare providers and policymakers from Sep 2015 until May 2016, at different locations in Tehran, Iran.

    Results: We identified four categories and eight subcategories of financial barriers affecting access to healthcare services among PWD. Four categories were related to health insurance (i.e. lack of insurance coverage for services like dentistry, occupational therapy and speech therapy), affordability (low income for PWD and their family), financial supports (e.g. low levels of pensions for people with disabilities) and transportation costs (high cost of transportation to reach healthcare facilities for PWD).

    Conclusion: Financial problems can lead to poor access to health care services. To achieve universal health coverage, government should reduce health insurance barriers and increase job opportunities and sufficient financial support for PWD. 



  • XML | PDF | downloads: 142 | views: 442 | pages: 516-524

    Background: Siblings of children with disabilities are the most likely family members to be affected by the child's disability due to the long-lasting nature of relationships between siblings compared to those of other family members. The aim of the present study was to compare the emotional-behavioral difficulties (EBD) in siblings of children with and without Sensory Impairments (SI).

    Methods: The statistical population of this causal-comparative research included all siblings of children with and without SI in Shiraz, southern Iran in 2016. The sample consisted of ninety-one siblings of children with (38) and without (53) SI in Shiraz. Sample of siblings of children with SI was recruited by purposeful sampling and sample of siblings of children without sensory impairments were selected through a multistage random sampling method. Strengths and Difficulties Questionnaire (SDQ) was utilized for measuring EBD. Two way ANOVA and MANOVA tests were used for data analyses.

    Results: Total EBD and two subscales of EBD (emotional problems and peer relationship problems) in siblings of children with SI were significantly greater than the comparison group (P<0.001). Furthermore, no significant difference was observed in the two subscales (conduct problems, and hyperactivity) between these two groups.

    Conclusion: This study provides strong evidence that siblings of children with SI are significantly at a higher risk of psychological problems, and accordingly we suggest for the related supports and services.



  • XML | PDF | downloads: 136 | views: 439 | pages: 525-530

    Background: A few studies have been done on the molecular analysis of Iranian influenza A isolates M gene.

    Methods: In 2014, nasal swabs collected from outpatients with clinical symptoms in the hospital clinics of Tehran, Iran were subjected for influenza detection and subtyping using Real-Time RT-PCR. Sequence and phylogenetic analysis performed on four randomly selected isolates from each subtype (H1N1 and H3N2) using neighbor-joining method.

    Results: Phylogenetic dendrograms drawn based on M nucleotide sequence of H1N1 isolates showed close relatedness with Omanian isolates while the most isolates of H3N2 have clustered with Kuwait isolates and isolates from outside of geographical location. Amino acid sequence analysis showed S31N substitution in all isolates rendering the virus resistant to adamantanes.

    Conclusion: This study determined the sequence identity and phylogenetic relatedness of M gene sequence got from Iranian influenza A isolates to elucidate the modality of relationship of this gene in comparison with its counterparts from other regions.


  • XML | PDF | downloads: 143 | views: 451 | pages: 531-540

    Background: Endoplasmic reticulum aminopeptidases 1 and 2 (ERAP1 and 2) are involved in blood pressure regulation and single nucleotide polymorphisms (SNPs) of these genes have been linked to preeclampsia. This study intended to assess the association of ERAP1 and 2 genes polymorphism with Iranian preeclamptic women.

    Methods: In this case-control study, 148 preeclamptic and 133 pregnant women were selected from the Kosar Hospital, Qazvin, Iran, during 2013-2015. In order to genotype the subjects for rs28096, rs30187, rs26653, rs3734016, rs34750 and rs2549782, rs17408150 for ERAP1 and 2 genes, respectively, Real-Time PCR allelic discrimination approach was exploited.

    Results: Neither allelic nor genotype frequencies of all seven polymorphisms were significantly different between two groups. Though, ACGACTT and GTCAGGA haplotypes were related with decreased (P=0.0079, OR=0.559, 95% CI: 0.363-0.861 and P=0.02, OR=0.417, 95% CI: 0.194-0.896, respectively), but ACGACGT and GTGACTT haplotypes were associated with an increased (P=0.00082, OR=3.657, 95% CI: 1.630-8.206 and P=0.02, OR=2.401, 95% CI: 1.119-5.151, respectively) risk of preeclampsia. Moreover, some positions were detected to be in linkage disequilibrium.

    Conclusion: Ongoing investigation resulted differently from before performed studies considering the role of ERAP1 and ERAP2 gene polymorphisms in predisposing women to preeclampsia, emphasizing on the genetic structure differences among various racial populations.


  • XML | PDF | downloads: 319 | views: 551 | pages: 541-548

    Background: Despite huge advances in improving most health indicators, Iranian primary health care (PHC) has faced several problems in improving the quality of care inside the health care system. Developed countries with similar problems have used various models of PHC governance for improving quality in their PHC system. This study aimed to obtain health professionals’ perspectives about the suitable pillars and components of Iran's PHC governance model.

    Methods: A purposeful sampling method was used to select seven participants who had a minimum of five years of experience in PHC and background education in the field of medical sciences. Between Jan and Jun 2015, three focus group discussions (FGD) were conducted with seven PHC experts in Tabriz. Data were analyzed using the conventional content analysis method.

    Results: The eight main categories including quality improvement, management and leadership, community involvement and customer participation, effectiveness of PHC, human resource development, safety, health care evaluation and audit, and health information management plus 51 sub-categories were identified according to participants' expects about the essential pillars and components for Iranian PHC governance model.

    Conclusion: Pillars that suggested for designing Iran’s PHC governance model are presented according to internal informed expert’s opinions and taking into account PHC system real status. By adding the degree of importance for each component and proper performance indicators to this collection, assessing the progress of the PHC system towards excellence will be possible and it will prevent any mental judgments about system performance.



Letter to the Editor